It's an emergency!

Emergency physicians are acute generalists who see patients at their most vulnerable

Doctors who are decisive and quick-thinking may be well suited to a career in emergency medicine, says Professor George Braitberg, director of emergency medicine and a consultant toxicologist at Southern Health in Melbourne.

“It suits doctors who like to multitask and who enjoy dealing with a number of different hospital and external services”, says Professor Braitberg, who is also professor of emergency medicine at Monash University.

Doctors considering the field need strong interpersonal skills, as emergency physicians not only liaise with other doctors in the hospital, but also with paramedics, allied health workers, nurses and even police.

Professor Braitberg says this means emergency medicine suits doctors with an interest in education. He adds that many emergency physicians complete a second degree in education.

The specialty also lends itself to clinical research, given the huge numbers of patients that come through emergency departments. For instance, the three emergency departments at Southern Health see about 190 000 patients each year.

Many emergency physicians are also involved in management or administrative-type roles (see also Medical Mentor, page C5), perhaps because they liaise with so many aspects of the health system.

“We are systems analysts. We think about systems, and the context in which the patient is being treated. There’s a lot of interest in patient flow and how health systems interact”, says Professor Braitberg.

One key outcome of this interest in systems has been the introduction of the national emergency access target, which aims to ensure that 90% of patients progress through the emergency department within 4 hours.

Professor Braitberg loves the variety of work he is able to do as an emergency physician.

“I’m fortunate in my position as I can do it all. I see patients, plus I do research, teaching and administrative work. Emergency medicine lends itself to that sort of career; or you can develop the [particular] side of your work that you want to develop”, he says.

Clinically, emergency physicians are true generalists who see an incredible variety of presentations.

“I like being able to see undifferentiated patients — people don’t present with a diagnosis, they present with symptoms. Your role is to look at the symptoms and signs and develop a provisional diagnosis. It has an intellectual side.”

There are also a number of subspecialty options including toxicology, disaster medicine, hyperbaric medicine and trauma.

Professor Braitberg says one of the misconceptions about the specialty is that it’s just about triaging patients.

“The role of the emergency department is to undertake resuscitations, provide the first essential treatment, make a provisional diagnosis, and refer patients to the most appropriate person. We do the same things as other doctors, but in a truncated period of time. In this time we have the opportunity to affect the lives of our patients and their families in a very meaningful way.”

Although emergency physicians do not have a long-term association with patients, Professor Braitberg says he gains incredible satisfaction from talking to patients and families, particularly because these interactions happen at such an intense time.

Professor Gary Geelhoed, director of the emergency department at the Princess Margaret Hospital for Children in Perth, says he does miss the ongoing patient relationships that he had when he was a rural general paediatrician.

Another downside is that the remuneration in the specialty is “pretty ordinary” compared with some specialties, says Professor Geelhoed, mainly because emergency physicians don’t generally work in the private sector.

However, he says working in an emergency department can be very flexible, and allows clinicians to “have a life outside medicine”.

“Emergency medicine can be full on, but once you walk away you hand over to someone else”, says Professor Geelhoed, who spends his down time playing sport and music.

He adds that the specialty is highly portable, allowing clinicians to work all over the country, and is well suited to part-time work. It is also easy to arrange holidays because there is no need to make arrangements to cover a patient load.

Professor Geelhoed says junior doctors considering the specialty need to relish a challenge and to be flexible. They also need the confidence to accept that they will never be an expert in any one area of medicine.

However, for Professor Geelhoed this is the main appeal of the specialty.

“We are generalists. We deal with everything from broken arms, to psychiatric problems, to kids with fever. The variety is enormous. I enjoy that, rather than operating only on the left elbow.”

Training as an emergency physician

After completing 2 years of basic training ,which is normally Postgraduate Year 1 and Postgraduate Year 2,emergency medicine registrars need to complete at least 1 year of provisional training. A primary exam must be completed at any stage during provisional or basic training. This is followed by at least 4 years of advanced training, which includes 30 months of emergency training and 18 months of non-emergency training. The fellowship exam needs to be completed in the final year of advanced training. The program offers registrars substantial flexibility (see also Registrar Q+A). For instance, all training can be done part-time, and registrars can choose whether they complete all their training in one state, or all over the country.

Sophie McNamara

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